The pharmacotherapeutic management of obstructive sleep apnea

ABSTRACT

Introduction: Obstructive sleep apneas are a frequent clinical condition in which there are momentary interruptions or reductions in breathing activity. To date, the gold standard therapy is the use of Continous Positive Airway Pressure (CPAP). But, due to the relatevely high frequency of poor compliant patients, there is the need to research possible pharmacological treatments for obstructive apnea (OSA).

Areas covered: A recent study divided OSA into four major phenotypes. With this characterization in hand, the authors have reviewed the pharmacological treatments present to date according to the different phenotypes in which they could be used. Afterwards, they analyzed the efficacy of different medicaments for the therapy of the residual (despite CPAP treatment) excessive day-time sleepiness (EDS) that often afflicts OSA’ patients.

Expert opinion: Different drug classes have been evaluated, with some positive results. However, there is still the need to better define treatment strategies for every single phenotype. This underlines the importance to avoid considering the pathology like a single entity without any differences between each single form. The authors are concerned about the risk that, treating only EDS, patients could reduce their compliance to CPAP, thus not reducing the cardiovascular risk associated with OSA.

KEYWORDS:

• Apnea
• drug
• OSA
• sleep
• sleepiness
• therapy

Article highlights

• OSA is not a single disorder, but different phenotypes associated to different physiopathological mechanisms exist

• CPAP remains the gold standard therapy in OSA’ patients

• There is a lack of evidence for a clinical usefulness of drug treatment in reducing AHI in OSA

• Drugs acting on impaired anatomy, on upper-airway dilator muscles, on high arousal threshold and on high loop gain, have to be better studied in order to define a clear target therapy

• Residual EDS has to be considered as another target therapy in OSA’ patients. Solriamfetol has obtained the most relevant results in this field

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One referee declares that they have a financial interest in Apnimed, Inc, who are undertaking research on obstructive sleep apnea pharmacotherapy. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript was not funded.